Universal Student Hospital Orientation

1. Universal Student Hospital Orientation A Collaborative Project of the Nassau Suffolk Coordinating Council of Nursing Education and Practice and the Nassau Suffolk Hospital Council Inc. Effective Fall 2010 Final Copy/Presented to NSHC 7-16-10

2. Introduction • This presentation is to be viewed by all student nurses in advance of beginning their clinical rotation annually. • It in no way replaces the site specific information that will be covered by faculty and or institutional personnel upon arrival in the institution. • Each school will send a letter to the individual hospitals they are using for student rotation attesting to the fact that the students have completed the program and scored an 80 or better on the post-test.

3. Topical Outline • Asepsis/Infection Prevention • Culture • Environmental/Fire Safety • HIPAA/Confidentiality • National Patient Safety Goals • Medications • Communication • Environment

4. Cultural Competence

5. Culture • Shared values, beliefs, customs, symbols • Learned and passed on • Provides meaning for group members existence together • Road map/blueprint to comprehend unwritten rules for living.

6. Ethnicity Affiliation with a group often linked by: • Race • Nationality • Language • Common cultural heritage

7. Ethnocentrism • Belief that own cultural group’s belief and values are: • Superior • Most acceptable • Stems from lack of exposure or ignorance

8. Stereotyping • A fixed and distorted generalization made about all members of a group • Has negative results • No attempt to learn about the individual

9. Prejudice • “An injury or damage resulting from some judgment or action of another in disregard of one’s rights” Webster’s Ninth CollegiateDictionary • Strongly held opinions about some topic or group of people • Stems from: • Ignorance • Misunderstanding • Past experience • Fear

10. Discrimination • Acting on prejudice • Denying the other person’s fundamental right.

11. Confidentiality And HIPAA

12. Confidentiality • HIPAA - Health Information Portability and Accountability Act • PHI - Protected Health Information • EVERY patient’s Right

13. Ethical Issues in Health Care • Both legal and ethical principles apply in the delivery of health care, sometimes leading to conflicts: • Government Regulations • PSDA (Patient Self-Determination Act of 1991) – Federal Law • Patient Bill of Rights – NYS • Health Care Proxy Law - NYS

14. Ethical Issues in Health Care (cont’d) • Patient’s rights under the law • Access to medical record • Patients with disabilities • Patient Self-Determination Act • NYS Health Care Proxy Law • Patient’s Bill of Rights • Informed Consent

15. ANA Code of Ethics for Nurses • Make explicit the primary goals, values, and obligations of the profession of nursing. The code serves the following purposes: • It states the ethical obligations and duties of every individual who enters the nursing profession; • It is the profession’s nonnegotiable ethical standard; • It is an expression of nursing’s own understanding of its commitment to society.

16. Infection Prevention and Asepsis

17. INFECTION PREVENTION TRAINING REQUIREMENTS • CDC • New York State Departments of Health & Education • Suffolk County Department of Health • Joint Commission • OSHA Blood borne Pathogen Standard • OSHA Tuberculosis Standard • EPA

18. MODES OF TRANSMISSION • Contact • direct • indirect • Droplet • Airborne • Common vehicle • Vector borne

19. BREAKING THE CHAIN OF INFECTION CONTROL OF THE MODES AND ROUTES OF TRANSMISSION Infectious Agent Susceptible Host (Person Likely To Get The Disease) Reservoirs (Host of Infectious Agent) P Portal of Entry (How Infectious Agent Enters the Host) Portal of Exit (How Infectious Agent Leaves Host) Means of Transmission (How Infectious Agent Travels)

20. Antibiotic resistant organisms MRSA VRE VISA VRSA ESBLs E.coli Klebsiella pneumoniaeOrganisms with Increasing ResistanceStreptococcal pneumoniaePseudomonas-Stenotrophomonas maltophiliaMultiply Drug Resistant TB

21. Clostridium difficile Leading cause of hospital acquired diarrhea Antibiotics major factor Spore forming Difficult to kill – sterilization needed Lasts in environment Hand washing – alcohol based gel ineffective

22. HANDWASHING Single most important component of an Infection Prevention program Hands must be washed with soap & water when: Before and after contact with patients, body fluids, specimens, and contaminated or soiled item. Between “clean” and “dirty” procedures on the same patient. After removing gloves. Before and after performing invasive procedures. After using the bathroom. Before eating. When your hands are visibly soiled. After coughing and sneezing.

23. ALCOHOL BASED HAND GEL The alcohol based hand antiseptic should adequately wet hands. Allow to air dry. Alcohol gel is appropriate for hand antisepsis before and after patient care, except when the hands are visibly soiled. Do not use if the patient has C.difficile.

24. Nurses Nail Care • Artificial nails, tips, wraps banned. • Natural nails ¼ inch long past fingertip • Intact nail polish-all healthcare workers that have pt. contact. • Neonatal nursery in Oklahoma babies died, PSAE infection, CDC, State DOH –tested staff –genotype for strain done and found 2 nurses, 1 with artificial nails and the other with long nails had same strain on nails.

25. Recommended Hand Hygiene Technique • Handrubs • Apply to palm of one hand, Rub hands together coveringall surfaces until dry • Volume: based on manufacturer • Handwashing • Wet hands with water,apply soap, rub hands together for at least 15 seconds • Rinse and dry with disposable towel • Use towel to turn off faucet Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.

26. OSHA BLOODBORNE PATHOGEN STANDARD EXPOSURE CONTROL PLAN The Occupational Health and Safety Administration requires the employer to protect employees from exposure and contamination from the blood and body fluids of another person. The written Exposure Control Plan is found in the Infection Control Manual. • THE PLAN INCLUDES : • Standard Precautions • Housekeeping procedures to ensure cleanliness and sanitation • Hepatitis B vaccinations for employees at risk • Exposure evaluation and follow-up for exposure incidents • Hazardous material container warnings such as biohazard labels • Confidential, accurate employee medical records • Engineering Controls • Work Practice Controls • Selection and use of protective clothing

27. PRECAUTIONS FOR ALL BLOOD AND OTHER POTENTIALLY INFECTIOUS BODY FLUIDS Standard Precautions Applies to all patients regardless of diagnosis or presumed infection status. Apply to: - blood - all body fluids, secretions, and excretions except sweat regardless of whether or not they contain visible blood. non-intact skin, mucous membranes Assumes that each person is potentially infectious and contagious.

28. To protect yourself from exposure, you must wearPersonal Protective Equipment (PPE) Gloves (vinyl & latex) gowns(fluid proof, fluid resistant) protective eyewear mask(surgical, non-surgical, respirator) All PPE should be removedIMMEDIATELYand disposed of according to Hospital policy.

29. Prior to entering the patient’s room:1.Put on protective garments before entering the patient's room2.Put on mask3.Put on protective eyewear (if necessary)4.Put on gown, tie at neck and back5.Don disposable gloves Leaving the patient’s room:1.Remove protective garments before leaving the patient's room.2.Take off gloves, turning them inside out when removing. 3.Take off gown, turning back into front so that inside of gown is on the outside.4.Take off mask or respirator and eye protection.5.Discard in clear waste receptacle.6.Wash hands. SEQUENCE OF PUTTING ON AND TAKING OFF PPEs

30. EXPOSURE TO BLOOD AND/OR BODY FLUID Needle stick or sharp object injury: Wash the area thoroughly with soap and water If blood spills or splashes on your hands: Wash hands thoroughly with soap and water If blood spills or splashes in your eyes: Be aware of location of eye wash station Flush eyes with large amounts of water Notify your Supervisor Complete an incident report Go to the Emergency Department within 30 minutes of the incident

31. Reference Source: www.joint commission . org National Patient Safety Goals

32. National Patient Safety Goals • The purpose of the National Patient Safety Goals is to improve patient safety. The Goals focus on problems in health care, safety and how to solve them.

33. Why Performance Improvement? • The purpose of the Performance Improvement Program is to do the right thing at the right time, and for the right reasons, for our patients. • The Interdisciplinary Performance Improvement Program supports hospital departments and staff in achieving standards of “Excellence” and Patient Safety

34. Dimensions of Performance Doing the Right Thing • Efficacy – Are we producing the desired effect? • Appropriateness – Are we doing the proper thing?

35. Dimensions of Performance Doing the Right ThingWell Are we doing the right things • Timely • Effectively • Safely • Efficiently • With Respect and Caring

36. Patient Safety Facts • Institute of Medicine reported that 44,000 to 98,000 people die in the US hospitals each year as a result of medical errors.

37. Medical Error • Medical Errors happen when something that was planned as part of medical care doesn’t work out, or when the wrong plan was used in the first place • They can happen during even the most routine tasks • Most errors result from problems created by today’s complex healthcare system; but errors also happen when we don’t communicate well

38. The Good News • Most medical errors are preventable

39. Nurses – The Patient Safety “Ace” A – Advocate C – Caregiver E - Educator

40. Nurses the Patient Safety “ACE” Advocate Assure that our policies and procedures are executed as intended Report unsafe practices Speak Up for our patients Coordinate Care Communicators

41. Nurses the Patient Safety “ACE” Care Giver Practice within our scope of practice Assess and communicate effectively Create effective plans of care Execute our plans of care Create safe environments

42. Nurses the Patient Safety “ACE” Educator Teach patients & families to participate in their care Inform them about their illness Infection control practices Medications Treatments Safety Precautions After Hospital Care

43. NPSG - Improve the Accuracy of Patient Identification • Use two patient identifiers when providing care, treatment or services (administering medications, handling specimens, during surgery, blood transfusions, procedures and other treatments). • It is necessary to know what the institution you are in is using as their two identifiers. Additionally you must know how the institution handles those who are hearing impaired or non-verbal. • Ask patient to state name and date of birth • Check information against a source document • Utilize the Surgical & Invasive Procedure Protocol Perioperative Check List and Verification, Surgical Site Marking, Time-out • Specimen Containers are labeled in the presence of the patient • Two persons verify blood transfusions Never use the patients room number or physical location as an identifier!

44. NPSG – Improve the Effectiveness of Communication Among Caregivers • Telephone Orders and Test Results are written down and verified with a “Read-back” – get confirmation! • Do Not Abbreviate: Morphine, Magnesium, Daily, Every Other Day, Heparin, Coumadin, Unit, International Units, Both Eyes, and • Always Use Leading Zeros, Never Use Trailing Zeros • Measure and Improve the timeliness of reporting and receipt by the caregiver of Critical Test Results & Critical Values. • Standardize approach to “hand off” communication & includes opportunity to ask and respond to questions; verifying information was understood

45. NPSG - Improve the Safety of Using Medications • ‘Look-alike/Sound-alike’ drugs used in the organization are identified & actions taken to prevent errors involving the interchange of these drugs. • Label all medications, medication containers (e.g., syringes, medicine cups, basins), or other solutions on and off the sterile field. Discard unused liquids.

46. NPSG - Improve the Safety of Using Medications • Reduce the likelihood of patient harm associated with the use of anticoagulation therapy. • Defined anticoagulation management program • Use oral unit-dose or pre-mixed infusions • Establish monitoring practices • Use approved protocols • Utilize INR for monitoring • Utilize a food/drug interaction program • Assess baseline and ongoing laboratory testing • Staff, patients and families are educated to anticoagulation therapy • Anticoagulation Safety Practices undergo evaluation

47. Reduce the Risk of Healthcare Acquired Infections • Comply with current Centers for Disease Control and Prevention (CDC) Hand Hygiene guidelines. • Manage as sentinel events all identified cases of unanticipated death or major permanent loss of function associated with a healthcare acquired infection. • Implement evidence-based practices to prevent • health care-associated infections due to multi-drug resistant organisms in acute care hospitals. • central line associated infections. • surgical site infections

48. NPSG- Accurately and Completely Reconcile Medication Across the Continuum of Care • Obtain and document patient’s current medications upon admission/entry • Compare the list to those ordered and resolve discrepancies • Communicate a complete list of the patient’s medications to the next provider of service when transferred to another setting, service, practitioner or level of care within or outside the organization. The next provider checks the medication reconciliation list again to make sure it is accurate and in concert with any new medication to be ordered/prescribed. • The complete list of medications is provided to the patient on discharged from the organization.

49. NPSG – Reduce the Potential of Patient Harm Resulting from Falls • Implement a fall reduction program that includes • An evaluation as appropriate to the patient, the setting and services provided; • patient, family and staff education; • and program effectiveness

50. NPSG – Encourage patients’ active involvement in their own care as a patient safety strategy • Define and communicate the means for patients and their families to report concerns about safety and encourage them to do so. • Provide patients and families with information regarding infection control practices • Describe to patients the methods used to prevent adverse events in surgery (Universal Protocol) • Encourage patients to report concerns